Physician-led ultrasound interventions: Rapid diagnosis of lung cancer during the COVID-19 pandemic

Introduction: Lung cancer management depends upon a timely histological diagnosis. Unprecedented pressure on various diagnostic facilities were observed during the COVID-19 pandemic. In our hospital, physician-led thoracic ultrasound guided biopsies and Rapid-On-Site-Evaluation (ROSE) ensured the prompt enrollment in the lung cancer diagnostic pathway. Aim and objectives: The COVID-19 pandemic has affected the lung cancer pathway adversely due to aerosol generating procedures, infection control, limited bronchoscopy, endobronchial ultrasound and computed tomography (CT) sessions. During this challenging time, we aimed to maintain a swift and consistent lung cancer pathway, aided by physician-led ultrasound guided interventions. Method(s): A twelve-month prospective analysis was performed on a cohort of all patients with a histological diagnosis of lung cancer, examining methods used for tissue sampling. Result(s): Between April 2020 to March 2021, our lung multi-disciplinary meeting decided the clinical management of 91 patients with confirmed histology. 41% (37/91) of those had biopsies via physician-led ultrasound-interventions. Sites sampled yielding tissue diagnosis were;59% (22/37) supraclavicular fossa nodes, 30% (11/37) lung lesions, 5% (2/37) pleural lesions, 3% (1/37) bone and 3% (1/37) axillary lymph node. Conclusion(s): Our study shows that physician led ultrasound guided biopsies and ROSE are safe and robust for prompt and speedy lung cancer management. It has future research potentials. We welcome comments and experience of other teams in this regard.

Science, Medicine, and Cytology: A Pilot Program of the ASC Diversity Equity and Inclusion (DEI) Committee

Introduction: The percentage of pathology trainees who are underrepresented minorities is low. The DEI committee established a Science, Medicine, and Cytology summer pilot program to improve exposure to cytopathology focusing on DEI. Material(s) and Method(s): An online course was developed during the Covid-19 pandemic targeting underrepresented minorities at the high school and college level, and consisted of several didactic sessions, presenting the most common procedures involving cytologists, including fine-needle aspiration, rapid onsite evaluation, and smearing techniques. Interviews of cytopathologists were also included. Participants were surveyed for their demographic information and for an evaluation of the course. Result(s): 23 participants completed the survey (Table 1). The highest level of education was high school 16 (70%), college 6 (26%), and other 1 (4%). Self-identified demographics included 2 (9%) Hispanic, 9 (36%) Asian/Asian American, 2 (8%) Black / Black American, 6 (24%) White/Caucasian, 2 (8%) African, 1 (4%) Muslim American and 1 (4%) Sudanese. Household highest level of education was high school 2 (9%), some college 1 (4%), completed college 9 (39%), completed graduate program 9 (39%), 2 (9%) preferred not to answer. 14 (61%) participants have a family member in healthcare. The program met expectations for 20 (87%). The program format was effective and appropriate for their level of education for 23 (100%). The content helpful for 22 (96%). 13 (57%) considered healthcare as a potential career. 5 (22%) considered cytology as a career (Table 2). Conclusion(s): Evaluations were excellent, generating awareness of medicine and cytopathology. Individuals with families in healthcare were overrepresented, as there were barriers in reaching underrepresented minorities. The population that signed up was influenced by our ability offer the course online. Expansion to a wider audience would increase the number of attendees. (Table Presented).

Telecytology Makes Significant Contribution in ROSE with Great Accuracy - Experience During the COVID-19 Pandemic at Stony Brook University Hospital

Introduction: Telecytology (TC) has been used in rapid onsite evaluation (ROSE) of touch preparations (TPs) from core biopsies and smears from fine-needle aspiration (FNA) procedures. Although TC was established at our institution in 2010, utilization has fluctuated. The COVID-19 pandemic highlighted the value of TC for maintaining high-quality patient care with the advantages of minimizing contact with hospital personnel and patients, conserving personal protective equipment (PPE), and saving cytopathologists' time. However, the accuracy of TC compared to on site evaluation by cytopathologists has been a concern. This study aimed to address this question. Material(s) and Method(s): 697 ROSEs were identified from our quality assurance (QA) data base in 2021 (Q2-Q4) including 1) TC;2) onsite cytopathologist (OC);and 3) onsite cytotechnologistonly (OCT). Discrepancy rates between ROSE and final diagnoses were compared between TC and OC groups. A student T-test was performed to determine the statistical significance of the discrepancy rate between TC and OC. Result(s): Results are summarized in Table 1. On average, there were 26% FNA and 74% Cores by TP. The difference in discrepancy rates between TC and OC during the 3 quarters in 2021 is not statistically significant (p=0.5012). The type of discrepancy for TC was all minor while 17% major and 83% minor for OC. Conclusion(s): The value of TC for ROSE was highlighted during the pandemic, allowing cytopathologists to participate in ROSE while minimizing interpersonal contact at procedures, conserving PPE, and saving cytopathologists' time. TC provides as high quality as OC for ROSE service with statistically insignificant minor discrepancies with the final diagnosis. Although pandemic-related restrictions are easing, we anticipate that TC will continue to play a major role in ROSE.

Impact of the COVID-19 Pandemic on ROSE Utilization and Final Diagnostic, PD-L1 Immunohistochemistry, and Molecular Testing Yields of CT-guided Lung Biopsies

Introduction: The onset of the COVID-19 pandemic, with urgent implementation of safety protocols limiting the number of on-site personnel, curtailed the utilization of rapid on-site evaluation (ROSE) for CT-guided lung biopsies at our institution. The pandemic, therefore, created an opportunity to examine the role of ROSE in diagnostic adequacy and ancillary testing yield for CT-guided lung biopsies. Material(s) and Method(s): We retrospectively identified all CT-guided lung biopsies performed from 2017-2021. The utilization of ROSE, adequacy of final diagnoses, and ancillary testing yield (PD-L1 immunohistochemistry, next generation sequencing) were ed from pathology reports and compared between 2017-2019 and 2020-2021. Cases were considered nondiagnostic if a definitive neoplastic diagnosis could not be rendered (e.g., atypical or suspicious diagnoses) or the histologic features did not explain imaging findings. Chi-square tests of independence were performed to examine relations between variables. Result(s): 766 CT-guided lung biopsies were performed from 2017-2021;174 (23%) utilized ROSE. The use of ROSE had been steadily decreasing prior to the pandemic and essentially ceased at the onset of the pandemic and never returned to pre-pandemic volumes (Figure 1). Overall (2017-2021), ROSE was more likely to be associated with an adequate final diagnosis (p=.003) and successful molecular testing (p=.013). ROSE was not associated with adequacy of PD-L1 results (p=.797). Comparing the periods 2017-2019 and 2020-2021 (with decreased utilization of ROSE in the latter), there was a trend towards a higher percentage of inadequate final diagnoses (17 vs. 24%, p=.08). Conclusion(s): Overall, ROSE was associated with higher diagnostic and molecular testing yields for CT-guided lung biopsies. The COVID-19 pandemic markedly reduced ROSE use during these procedures;evaluation of the impact on clinical care is ongoing with further studies investigating lesion size, number of passes, and need for repeat procedures.

Telecytology versus in-room Cytopathologist for Endoscopic Ultrasound Fine Needle Aspiration or Biopsy of Solid Pancreatic Lesions.

BACKGROUND AND AIMS: Rapid On-Site-Evaluation (ROSE) with an in-room pathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing Endoscopic Ultrasound fine needle aspiration or biopsy (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and utilization of Telecytology (ROSE-T) to optimize clinical workflows, and to address social distancing mandates created during the COVID-19 pandemic. The purpose of this study is to compare diagnostic outcomes of ROSE-P and ROSE-T. METHODS: A single center cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. The primary outcome was overall diagnostic yield of cancer. All patients who underwent EUS-FNA were entered into a prospectively maintained database. Statistical analyses were performed using descriptive statistics and univariate analysis. RESULTS: There were 165 patients in each arm. There was no difference in diagnostic yield between ROSE-P and ROSE-T (96.4% vs 94.5%, p=.428). ROSE-T was associated with increased use of 22-gauge needles (p=.006) and more needle passes (p<.001). There was no significant difference in age, gender, lesion size, needle type, procedure times, or adverse events between the two groups (p<.05 for all). There were more pancreatic tail lesions sampled in the ROSE-P group (p<.001). CONCLUSION: Rapid on-site evaluation using Telecytology was not associated with any difference in final histologic diagnosis for EUS-FNAB of solid pancreatic masses. This has important implications for optimizing clinical workflows.

Rapid COVID-19 Testing and On-site Case Investigation and Contact Tracing in an Underresourced Area of Salt Lake City, Utah, December 2020-April 2021.

This case study describes how we paired free SARS-CoV-2 rapid antigen testing with on-site case investigation and contact tracing at a drive-through site in an underresourced area of Salt Lake City. Residents of this area had lower rates of employment and health insurance and higher rates of poverty than in the Utah general population. People were given an option to remain on-site and wait until their test results were ready. If a vehicle occupant received a positive test result, the case investigation occurred on-site; contact tracing with the other vehicle occupants was also initiated. People were provided resources to support isolation and quarantine. Bilingual staff who spoke Spanish were incorporated into the workflow. From December 2020 through April 2021, public health staff administered 39 587 rapid tests; 4094 people received a positive test result and 1133 stayed for on-site case investigation. More than half (60.5%) of people with a positive test result who agreed to stay for on-site case investigation were Hispanic or self-reported belonging to a non-Hispanic racial minority group (American Indian/Alaska Native, Asian, Black or African American, Native Hawaiian or Other Pacific Islander, or other racial identities). Pairing rapid antigen testing with on-site case investigation and contact tracing is feasible and improved the timeliness of case investigation by ≥1 day. On-site vaccination services were later integrated. Future emergency responses might consider assisting underresourced communities with on-site services that provide convenient and accessible public health interventions. By providing dependable and reliable services, we were able to achieve buy-in and become a consistent resource for those in the community.

Assessing ROSE for adequacy of EBUS-TBNA compared with a direct-to-cell block approach as a response to the COVID-19 pandemic.

INTRODUCTION: Rapid on-site evaluation (ROSE) has been used during the endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) procedure as standard practice. Because of the COVID-19 (coronavirus disease 2019) pandemic, our institute had had to discontinue ROSE and adopt a direct-to-cell block approach. In the present study, we aimed to determine whether this change has had significant effects on the cytopathology quality. MATERIALS AND METHODS: A total of 1903 EBUS-TBNA cases from 734 patients were collected (1097 cases with ROSE for 452 patients; 806 cases without ROSE but with direct-to-cell block for 282 patients). The clinical and cytology data were analyzed using SAS, version 9.4, software to render calculated standardized residuals and a fitted multivariate generalized linear model. RESULTS: On average, a biopsy from a patient with ROSE was 0.936 (=exp -0.066) times less likely to be reported as satisfactory compared with a biopsy from a patient without ROSE, although the difference was not statistically significant (P = 0.785). The inadequacy rate of EBUS-TBNA was 6.4% higher on average for cases with ROSE compared with a direct-to-cell block approach. However, this difference was also not statistically significant. The proportions of biopsies reported as diagnostic for malignancy and other were significantly different between the ROSE and no-ROSE groups with a standardized residual of 1.80 (P = 0.036) and -2.27 (P = 0.012), respectively. CONCLUSIONS: Discontinuing ROSE and using a direct-to-cell block approach had no negative effects on cytopathology quality. This practice can be considered acceptable during the COVID-19 pandemic when social distancing and the shortage of staff and supplies have resulted in challenges to delivering quality care to cancer patients whose treatment cannot be postponed.

A District General Hospital (DGH) EBUS Service: a different model

Dorset County Hospital set up its EBUS service in February 2020. The Respiratory consultant undertook 2 training courses and then undertook a period of direct EBUS training at Southampton General Hospital. The service continued throughout the COVID 19 pandemic. We have undertaken 45 cases between Feb 2020 and Aug 2021. 3/45 were non diagnostic. All cancer cases provided enough tissue for molecular studies. 1 case was abandoned due to desaturation once the vocal cords were anaesthetised, but there have been no other complications. Previously all of our EBUS cases had to be sent to Poole or Bournemouth Hospitals (now University Hospitals Dorset) meaning our patients had to travel. There is no real local provision for staging EBUS in Dorset. We do not have funding for Rapid OnSite Evaluation (ROSE) so the 2 Lung CNS and Advanced Nurse Practitioner make the slides in the endoscopy room, after training from the biomedical scientists. This approach has been supported by our Histopathologist. Now the ANP and endoscopy nurses will often operate the needle, due to only having 1 trained consultant and 1 junior Respiratory registrar. Using the nurses to undertake the needling has not been associated with a drop off in diagnostic yield and has allowed the service to be more robust/ We have 2 EBUS scopes, which have both been funded through charitable funding. It is possible to run a diagnostic EBUS service under sedation at a DGH, utilising the endoscopy staff and Lung CNS to take and process the samples. It is important to be creative with service models when recruitment is challenging.

A SINGLE CENTER COHORT ANALYSIS COMPARING ENDOSCOPIC ULTRASOUND FINE NEEDLE ASPIRATION BIOPSY FOR SOLID PANCREATIC LESIONS USING RAPID ON-SITE EVALUATION (ROSE) WITH IN-ROOM PATHOLOGIST VS TELECYTOLOGY

Background: Rapid On-Site-Evaluation (ROSE) with an in-room pathologist (ROSE-P) has been shown to improve the diagnostic yield of specimens obtained from patients undergoing Endoscopic Ultrasound Fine Needle Aspiration Biopsy (EUS-FNAB) of pancreatic lesions. Recently, there has been an increased interest and utilization of telecytology (ROSE-T) to address social distancing during the COVID-19 pandemic and to optimize clinical workflows. With ROSE-T, a technician equipped with a video conferencing capable microscope unit prepares the EUS-FNAB cytology slides, which are then examined by Cytopathologists remotely. The purpose of this study is to compare diagnostic outcomes of ROSE-P prepandemic with ROSE-T during the COVID-19 pandemic. Methods: A single-center mixed retrospective-prospective cohort study of patients who underwent EUS-FNAB of solid pancreatic lesions with ROSE was conducted. All patients who underwent EUS-FNA were entered into a prospective database. The retrospective arm was patients who underwent ROSE-P pre-pandemic, whereas the prospective arm was patients who underwent ROSE-T during the pandemic. 165 patients in each group were needed to detect a 10% difference in diagnostic yield between the two groups, based on sample size calculation. An interim analysis was performed based on available data. Statistical analyses were performed using descriptive statistics and univariate analysis. Results: A total of 295 patients were enrolled in the study. 168 (57%) were in the ROSE-P group and 127 (43%) in the ROSE-T group. ROSE-T was associated with significantly more needle passes than ROSE-P (3.7 vs 3.0, p<0.0001). There was increased use of 22-gauge needle and decreased use of 25-gauge needles with ROSE-T during the pandemic (p = 0.012). There was no difference in age (63.4 vs 66.3, p=0.14), gender (43.5% vs 48.8 female gender, p=0.36), means mass size (27.2 vs 27.5 mm, p=0.14), mean procedure time (48.2 vs 46.2 minutes, p=0.92), adverse events (0.6% vs 0%, p=0.38), or diagnostic yield (97% vs 98.4%, p=0.38) between ROSEP and ROSE-T respectively. Conclusion: Rapid on-site evaluation using Telecytology was associated with more needle passes and more frequent use of 22-gauge needles as compared to ROSE-P;however, there was no difference in other important outcomes such as diagnostic yield, procedure time, and adverse events. (Table Presented)

HYBRID ENDOSCOPIC ULTRASOUND IN THE COVID-19 ERA FOR THE TISSUE DIAGNOSIS OF SOLID LESIONS: AN INITIAL EXPERIENCE FROM A TERTIARY CARE CENTRE IN PAKISTAN

AIM: Endoscopic Ultrasound (EUS) is well-established mode of intervention for tissue acquisition in solid organs with rapid on-site evaluation (ROSE). In the Covid-19 era implementation of infection control mechanisms has led modified hybrid technique to get high diagnostic yield for tissue sampling. Combination of Covid-19 SOPs and tissue acquisition method outline this hybrid technique to get high diagnostic Yield.We share our initial experience of EUS cases performed with this approach without ROSE. METHODS: All 84 cases who underwent EUS guided biopsy from June 2020 till December 2021 were included. The Procedure was done in a negative pressure room with all SOPs as per institutional guidelines for patient and staff safety with a minimum number of persons during procedure. RESULTS: Among these cases, 55 were male, mean age 56 years (range 22-90), Mean duration of procedure 25 min mean (10-90 min). 63 came for organ targeted for malignant pathology include pancreas 35, liver 02, lymph nodes 17, subepithelial lesions 06, mediastinal lesions 08, common-bile duct/gall bladder 04. 17 cases had a multi-targeted biopsy for the additional staging of disease. The number of 'passes' with the needle was average 02 with single pass 17, two pass 39, three passes 11, multitarget single pass in 17. Needle size (Franseen design) used for procedures was 22G in 78 cases and 25G in 6. Common tissue diagnoses include pancreatic adenocarcinoma 26, neuroendocrine tumours 04, tuberculosis 05, gastrointestinal stromal tumours 02, leiomyoma 03, lymphoma 03, metastatic renal cell carcinoma 04, squamous cell carcinoma 04, cholangiocarcinoma/ gall bladder adenocarcinoma 07, Sarcoma 02 and solid pseudopapillary epithelial neoplasm of pancreas (SPEN) 01. There were no immediate or early complications in all cases. CONCLUSIONS: Hybrid EUS in Covid 19 Era has emerged as a useful/cost-effective and safe approach to get tissue yield without the need for ROSE.

Assessing Rapid On-Site Evaluation (ROSE) for Adequacy of Endobronchial Ultrasound Transbronchial Needle Aspiration (EBUS-TBNA) Procedures Compared to A Direct-to- Cellblock Approach As a Response to COVID-19 Pandemic

Background: Rapid on-site evaluation (ROSE) of endobronchial ultrasound transbronchial needle aspiration (EBUS-TBNA) has been used as standard to improve diagnostic yield and to triage samples for additional testing. A method has been prompted to leveraging the expertise of cytotechnologists only or the utility of tele cytology. However, due to the COVID-19 pandemic, our institution had to discontinue ROSE for EBUS-TBNA, and instead adopted a direct-to-cellblock approach. This study aims to determine if removing ROSE affected the adequacy of samples obtained from the EBUS-TBNA cases, and if this new approach should be employed continuously for an extended period without jeopardizing the standard of care to the patient since we are still in the pandemic. Design: We collected data of total 1903 EBUS-TBNA cases from 734 patients. 1097 cases were performed from 1/2019 to 3/2020 with ROSE on 452 patients;806 cases were performed between 4/2020 to 12/2020 without ROSE on 282 patients, and the sample was sent directly to be processed as a cell block. Data variables collected included patient's age and gender, specimen sites and frequencies, and final cytopathological diagnosis. Calculated standardized residuals and fitted multivariate generalized linear model were performed at Moffitt Cancer Center & Research Institute Biostats Core using software SAS 9.4. Results: On average, holding specimen site variable constant, a biopsy from a patient with ROSE is 0.936 (=exp -0.066) times less likely to be reported as 'Satisfactory' as compared to a biopsy taken from a patient without ROSE, and this difference is not statistically significant (p = 0.785). Among all 6 categories of diagnosis, biopsies reported as 'Diagnostic for malignancy' are significantly different between ROSE and no ROSE groups with the standardized residual of 1.80 (p = 0.036) & only other significantly different category was 'Other';however, a very small number of biopsies were reported in this category (3.5%). Conclusions: The inadequacy rate of EBUS-TBNA was 6.4% higher on average in cases with ROSE when compared to a directto- cell block approach in this data set, however this difference was not statistically significant. This suggests that ROSE could be discontinued in favor of a direct-to-cell block approach. Although additional studies are needed, the discontinuation of ROSE for EBUS-TBNA would decrease the time and cost burden on cytopathology service while providing the same quality of care to the patient. (Table Presented).

Telecytopathology for Rapid On-Site Evaluation (ROSE) Adequacy in Fine-Needle Aspiration of Pancreatic and Lung Lesions during COVID19 Pandemic

Background: Telecytopathology (TCP) has a variety of different applications in clinical practice and is becoming more widely utilized especially during COVID pandemic. More recently, TCP use has been increasingly applied to the rapid on-site evaluation (ROSE) at our institution with immediate assessment by viewing cytologic smears remotely over web conferencing platform (zoom). As part of our quality control evaluation, we retrospectively investigated ROSE adequacy in two of the busiest FNA procedures at our institute (pancreas and lung) via TCP. Design: The study includes retrospective review of 151 of pancreatic lesions and 242 lung lesions over a two-year period. The air dried Diff-Quick slides were evaluated on site for adequacy by the cytopathology fellow/ cytotechnologist and cytopathologists via TCP at the same time. The ROSE adequacy diagnosis is recorded and transcribed to the preliminary report. We reviewed the adequacy and preliminary ROSE assessment and compared it to the final diagnosis as the gold standard. The non-diagnostic rate and discrepancy rate between initial and final diagnosis were calculated. Results: A total of 393 adequacy assessments of pancreas (151, 38%) and lung (242, 62%) were analyzed. Overall, 114 (75%) pancreatic cases and 199 (82%) lung lesions had adequate diagnosis at the time of the ROSE, while 37 (25%) of pancreatic cases and 43 (18%) of lung cases had non-adequate ROSE read specimens. Concordance between initial assessment of diagnosis and the final cytological diagnosis was identified in 94% (142 out of 151) of pancreatic cases and 93.4% (226 out of 242) of lung cases. Of the discordant cases, the final diagnosis was upgraded to adenocarcinoma in 7/9 pancreatic lesions and either SCC, adenocarcinoma or atypia in 5/16 lung lesions. The final diagnosis was downgraded to benign category in 2/9 pancreatic lesions and 11/16 lung lesions. Conclusions: Telecytopathology ROSE evaluation of pancreatic and lung lesions may have several advantages over in-person ROSE, including providing a suitable alternative technology, mitigating disease transmission during the COVID19 pandemic, while maximizing resources to allow more efficient use of the pathologist's time, thereby improving efficiency, eliminating downtime, and answering the increasing demand for on-site adequacy evaluation.

Technical aspects of the use of cytopathological specimens for diagnosis and predictive testing in malignant epithelial neoplasms of the lung.

Lung cancer is a leading cause of cancer mortality worldwide but recent years have seen a rapidly rising proportion of cases of advanced non-small cell carcinoma amenable to increasingly targeted therapy, initially based on the differential response to systemic treatment of tumours of squamous or glandular differentiation. In two-thirds of the cases, where patients present with advanced disease, both primary pathological diagnosis and biomarker testing is based on small biopsies and cytopathological specimens. The framework of this article is an overview of the technical aspect of each stage of the specimen pathway with emphasis on maximising potential for success when using small cytology samples. It brings together the current literature addressing pre-analytical and analytical aspects of specimen acquisition, performing rapid onsite evaluation, and undertaking diagnostic and predictive testing using immunocytochemistry and molecular platforms. The advantages and drawbacks of performing analysis on cell block and non-cell block specimen preparations is discussed.

Rapid onsite evaluation uses a very small proportion of total material aspirated at endobronchial or endoscopic ultrasound in the investigation of suspected thoracic malignancy.

INTRODUCTION: The objectives were: to measure the proportion of aspirated material used to make direct slides for rapid onsite evaluation (ROSE) at endobronchial (EBUS) and endoscopic ultrasound (EUS) in suspected thoracic malignancy; and to correlate pass weights with ROSE category and needle size. METHOD: All EBUS and EUS cases for possible thoracic malignancy October 2018-May 2019 were included. All material from each pass was expelled into a Petri dish. One drop of material was placed on each of two slides; one used for ROSE, the other fixed and remaining material processed to cell block. Dish and slides were weighed before and after this procedure on a sensitive balance and weight of aspirate and slide material calculated. When ROSE identified malignancy, slide production ceased but target sampling for ancillary studies continued. RESULTS: ROSE accuracy was 96.8%. Mean percentage by target of aspirated material used to make direct slides for ROSE was 1.9% in malignant cases and 3.6% in non-malignant cases (P = .027 for difference). Mean percentage by pass was 5.9%. Mean weight of a single aspirate was 128.8 mg. Mean weight of aspirates insufficient on ROSE (175.7 mg) was significantly higher than the mean weight of benign or malignant aspirates (117.1 and 114.0 mg, respectively). Mean weight of aspirates using 22G needles (132.6 mg) was significantly higher than that for 25G needles (87.1 mg). CONCLUSION: Material made into direct slides at EBUS and EUS and used in part for ROSE uses a tiny proportion of aspirated material with over 98% processed to cell block and available for ancillary testing in malignant cases.

Juggling the COVID-19 pandemic: A cytopathology point of view.

Since its first identification in China at the end of 2019, severe acute respiratory syndrome coronavirus 2 has rapidly spread all over the world, becoming an international healthcare emergency. In the era of coronavirus disease-2019 (COVID-19), several aspects of normal life, including those related to the medical activities, have been radically changed. Extraordinary measures have been adopted by different nations to cope with the rapid diffusion of COVID-19 all over the world. In hospitals, careful attention has been paid to manage infected patients with a possible detrimental effect for patients affected by other diseases. As with other medical fields, cytopathology laboratories have also drastically modified their activities to cope with the COVID-19 healthcare emergency. Here, the main effects of COVID-19 pandemic on the routine practice of cytopathology are summarised, focusing on the prioritisation policy adopted by cytopathologists worldwide.

A narrative review of lung cancer cytology in the times of coronavirus: what physicians should know.

In the modern era of personalized and precision medicine, lung cancer management needs to be carried out in a multidisciplinary manner. Among other disciplines, also cytopathology is key in diagnosis and treatment management of these patients. Indeed, cytopathology specimens are often the only source of available tissue material for morphological diagnosis and molecular purposes in order to guarantee an adequate treatment decision making, since surgical resection specimens are not available when lung cancer is diagnosed at advanced disease stages. Today, as an effect of the current severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) pandemic, cytopathology is reorganizing and reshaping many of its procedures and workflows, in order to ensure the safety of cytopathologists and laboratory personnel. In particular, careful attention should be paid on biosafety procedures when pulmonary cytological specimens are handled. In addition, also molecular cytopathology, that provides relevant information on the molecular status and on the potential sensitivity to target treatments, is undergoing major changes. In this setting, fully automated technologies, requiring minimal hands-on work, may be a valid option. The aim of this narrative review is to keep updated all the different professional figures involved in lung cancer management and treatment on how SARS-CoV-2 is modifying lung cancer cytopathology.

Interventional cytopathology in the COVID-19 era.

INTRODUCTION: The dramatic spread of COVID-19 has raised many questions about cytological procedures performed in and out of the laboratories all over the world. METHODS: We report a heterogeneous series of fine needle aspirations performed during the period of phase 1 of the lockdown for the COVID-19 pandemic to describe our experience and measures taken during this period. RESULTS: A total of 48 fine needle aspirations (ultrasound, computed tomography and endoscopic ultrasound guided) were processed and reported. CONCLUSIONS: Pre-existing procedures have been modified to allow healthcare professionals to work safely ensuring patients the necessary assistance with samples suitable for cellularity, fixation and staining for an accurate cytological diagnosis.